Hemophilia B
Conditions
Keywords
On-demand treatment, Hemostatic efficacy, Factor IX activity, Factor IX recovery, Factor IX inhibitor, Chinese
Brief summary
This study will evaluate the safety and efficacy of on-demand treatment with BeneFIX in Chinese hemophilia B subjects.
Interventions
BeneFIX for on-demand treatment of bleeding episodes were according to investigator prescription. FIX recovery was assessed by determining the FIX activity (FIX:C) levels in individual subjects. BeneFIX dosage for recovery assessments: single 75 IU/kg (±5 IU/kg) IV bolus infusion.
Sponsors
Study design
Eligibility
Inclusion criteria
* Subjects equal or more than 6 years of age with mild, moderate or severe hemophilia B (FIX activity: more than 5%, 1-5%, or less than 1%, respectively) * Subjects with previous exposure to FIX replacement therapy * If HIV positive, documented CD4 count more than 200/µL within 6 months of study entry
Exclusion criteria
* Diagnosed with any bleeding disorder in addition to hemophilia B * Current FIX inhibitor or history of FIX inhibitor (defined as \>ULN of the reporting laboratory) * Subject has no history of exposure to FIX products (previously untreated patient \[PUP\]) * Subject is currently utilizing primary FIX prophylaxis * Subjects anticipating elective surgery that may be planned to occur in the 6 months following study entry * Treated with immunomodulatory therapy within 30 days prior to study entry or planned use for the duration of their study participation * Participated in another investigational drug or device study within 30 days prior to study entry or planned participation for the duration of their study participation * Subjects with a known hypersensitivity to hamster protein * Significant hepatic or renal impairment (ALT and AST \>5 x ULN, bilirubin \>2 mg/dL or serum creatinine \>1.25 x ULN) * Prothrombin Time \>1.5 x ULN * Platelet count \<80,000/µL * Pregnant or breastfeeding women * Unwilling or unable to follow the terms of the protocol * Any condition which may compromise the subject's ability to comply with and/or perform study-related activities or that poses a clinical contraindication to study participation, in the opinion of the Investigator or Sponsor
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Investigator Hemostatic Efficacy Assessment of Participants After 8 Hours Post Infusion | 8 hours post infusion | Investigator Hemostatic Efficacy Assessment was based on response of bleeding episodes to BeneFIX treatment on 4-point rating scale: Excellent(1): definite pain relief or improvement in signs of bleeding starting within 8 hrs after infusion, with no additional infusion; Good(2): definite pain relief or improvement in signs of bleeding starting within 8 hrs or following infusion; Moderate(3): probable or slight improvement starting after 8 hours following infusion; No Response(4): no improvement at all between infusions or during 24 hour interval following an infusion, or condition worsens. |
| Investigator Hemostatic Efficacy Assessment of Participants After 24 Hours Post Infusion | 24 hours post infusion | Investigator Hemostatic Efficacy Assessment was based on response of bleeding episodes to BeneFIX treatment on 4-point rating scale: Excellent(1): definite pain relief or improvement in signs of bleeding starting within 8 hrs after infusion, with no additional infusion; Good(2): definite pain relief or improvement in signs of bleeding starting within 8 hrs or following infusion; Moderate(3): probable or slight improvement starting after 8 hours following infusion; No Response(4): no improvement at all between infusions or during 24 hour interval following an infusion, or condition worsens. |
| Percentage of Participants With FIX Inhibitor Development | Baseline up to 6 months | Incidence of FIX inhibitor was defined as any result determined as positive at local laboratory, and confirmed at central laboratory with Nijmegen assay result \>=0.6 Bethesda Unit (BU). Incidence was stratified by participant exposure history - Minimally Treated Patients (MTPs): those who had received at least one prior FIX infusion, and \<= 100 documented Exposure Days (EDs); while Previously Treated Patients (PTPs): those who had received \>100 documented prior EDs. When number of prior EDs for an individual was not known to be at least 100, participants were included in the MTP population. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Allergic-Type Allergic Reactions | Baseline up to 6 months | Hypersensitivity to undesirable (damaging, discomfort-producing and sometimes fatal) reactions produced by the normal immune system. Hypersensitivity reactions require a pre-sensitized (immune) state of the host. |
| Number of Infusions Required to Treat Each Bleed | Baseline up to 6 months | The number of BeneFIX infusions required to treat each bleeding episode were analyzed. The average frequency of BeneFIX infusions per hemorrhage incidence to treat every hemorrhage was equal to the total number of injections throughout the study divided by total number of hemorrhagic events. |
| Percentage of Participants With Red Blood Cell (RBC) Agglutination | Baseline up to 6 months | RBC Agglutination is the clumping of red blood cells in the presence of an antibody. The antibody or other molecule bonded multiple particles and joined them, creating a large complex. |
| Percentage of Participants With Thrombosis | Baseline up to 6 months | Thrombosis is the formation of a blood clot (thrombus) inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss. |
| FIX Incremental Recovery | Baseline (Visit 2) up to 6 months (Visit 4) | FIX recovery was assessed by evaluating FIX:C after initial exposure and following 6 months of repeated exposures to BeneFIX. A modified FIX recovery study was performed at Day 1 (Visit 2) and Month 6/Final/Early Termination visits (Visit 4) and when clinically indicated at the applicable on-demand visits. Blood samples for determination of FIX:C were collected immediately before BeneFIX infusion and at 30 minutes (±5 minutes) after the start of infusion. Post-infusion blood samples were collected via venipuncture in arm contralateral to arm used for infusion. |
| Percentage of Participants With Less Than Expected Therapeutic Effect (LETE) | Baseline up to 6 months | The incidence of LETE for on-demand treatment was defined as no response after each of 2 successive infusions within 24 hours for the same bleeding event in the absence of confounding factors. |
Countries
China
Participant flow
Recruitment details
Participants were enrolled in six centers in China.
Participants by arm
| Arm | Count |
|---|---|
| BeneFactor IX (BeneFIX) Participants received on-demand treatments with BeneFIX according to investigator's prescription over a 6-month (calendar day) period. A single 75 International Unit (IU)/kg (±5 IU/kg) intravenous (IV) bolus infusion of BeneFIX was given for recovery assessments. All BeneFIX administrations occurred in the clinic (hospital). | 35 |
| Total | 35 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 1 |
| Overall Study | Lost to Follow-up | 3 |
Baseline characteristics
| Characteristic | BeneFactor IX (BeneFIX) |
|---|---|
| Age Continuous | 25.7 Years STANDARD_DEVIATION 13.6 |
| Sex: Female, Male Female | 0 Participants |
| Sex: Female, Male Male | 35 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 19 / 35 |
| serious Total, serious adverse events | 2 / 35 |
Outcome results
Investigator Hemostatic Efficacy Assessment of Participants After 24 Hours Post Infusion
Investigator Hemostatic Efficacy Assessment was based on response of bleeding episodes to BeneFIX treatment on 4-point rating scale: Excellent(1): definite pain relief or improvement in signs of bleeding starting within 8 hrs after infusion, with no additional infusion; Good(2): definite pain relief or improvement in signs of bleeding starting within 8 hrs or following infusion; Moderate(3): probable or slight improvement starting after 8 hours following infusion; No Response(4): no improvement at all between infusions or during 24 hour interval following an infusion, or condition worsens.
Time frame: 24 hours post infusion
Population: FAS population included all participants who were treated and had at least 1 evaluable efficacy assessment after treatment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| BeneFactor IX (BeneFIX) | Investigator Hemostatic Efficacy Assessment of Participants After 24 Hours Post Infusion | 1.58 Units on a scale | Standard Deviation 0.71 |
Investigator Hemostatic Efficacy Assessment of Participants After 8 Hours Post Infusion
Investigator Hemostatic Efficacy Assessment was based on response of bleeding episodes to BeneFIX treatment on 4-point rating scale: Excellent(1): definite pain relief or improvement in signs of bleeding starting within 8 hrs after infusion, with no additional infusion; Good(2): definite pain relief or improvement in signs of bleeding starting within 8 hrs or following infusion; Moderate(3): probable or slight improvement starting after 8 hours following infusion; No Response(4): no improvement at all between infusions or during 24 hour interval following an infusion, or condition worsens.
Time frame: 8 hours post infusion
Population: FAS population included all participants who were treated and had at least 1 evaluable efficacy assessment after treatment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| BeneFactor IX (BeneFIX) | Investigator Hemostatic Efficacy Assessment of Participants After 8 Hours Post Infusion | 1.70 Units on a scale | Standard Deviation 0.72 |
Percentage of Participants With FIX Inhibitor Development
Incidence of FIX inhibitor was defined as any result determined as positive at local laboratory, and confirmed at central laboratory with Nijmegen assay result \>=0.6 Bethesda Unit (BU). Incidence was stratified by participant exposure history - Minimally Treated Patients (MTPs): those who had received at least one prior FIX infusion, and \<= 100 documented Exposure Days (EDs); while Previously Treated Patients (PTPs): those who had received \>100 documented prior EDs. When number of prior EDs for an individual was not known to be at least 100, participants were included in the MTP population.
Time frame: Baseline up to 6 months
Population: Safety Set (SS) population included all enrolled participants who had taken at least 1 dose of drug.The 'n' is signifying those participants who received study drug and were evaluated for this measure at the timepoint for each visit respectively.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| BeneFactor IX (BeneFIX) | Percentage of Participants With FIX Inhibitor Development | Total (n=35) | 2.86 Percentage of Participants |
| BeneFactor IX (BeneFIX) | Percentage of Participants With FIX Inhibitor Development | MTP (n=24) | 4.17 Percentage of Participants |
| BeneFactor IX (BeneFIX) | Percentage of Participants With FIX Inhibitor Development | PTP (n=11) | 0 Percentage of Participants |
FIX Incremental Recovery
FIX recovery was assessed by evaluating FIX:C after initial exposure and following 6 months of repeated exposures to BeneFIX. A modified FIX recovery study was performed at Day 1 (Visit 2) and Month 6/Final/Early Termination visits (Visit 4) and when clinically indicated at the applicable on-demand visits. Blood samples for determination of FIX:C were collected immediately before BeneFIX infusion and at 30 minutes (±5 minutes) after the start of infusion. Post-infusion blood samples were collected via venipuncture in arm contralateral to arm used for infusion.
Time frame: Baseline (Visit 2) up to 6 months (Visit 4)
Population: FAS population included all participants who were treated and had at least 1 evaluable efficacy assessment after treatment. The 'n' is signifying those participants who received study drug and were evaluated for this measure at the timepoint for each visit respectively.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BeneFactor IX (BeneFIX) | FIX Incremental Recovery | Visit 2 (n=30) | 0.760 IU/dL per IU/kg | Standard Deviation 0.222 |
| BeneFactor IX (BeneFIX) | FIX Incremental Recovery | Visit 4 (n=31) | 0.727 IU/dL per IU/kg | Standard Deviation 0.275 |
Number of Infusions Required to Treat Each Bleed
The number of BeneFIX infusions required to treat each bleeding episode were analyzed. The average frequency of BeneFIX infusions per hemorrhage incidence to treat every hemorrhage was equal to the total number of injections throughout the study divided by total number of hemorrhagic events.
Time frame: Baseline up to 6 months
Population: FAS population included all participants who were treated and had at least 1 evaluable efficacy assessment after treatment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| BeneFactor IX (BeneFIX) | Number of Infusions Required to Treat Each Bleed | 1.20 Infusions | Standard Deviation 0.86 |
Percentage of Participants With Allergic-Type Allergic Reactions
Hypersensitivity to undesirable (damaging, discomfort-producing and sometimes fatal) reactions produced by the normal immune system. Hypersensitivity reactions require a pre-sensitized (immune) state of the host.
Time frame: Baseline up to 6 months
Population: SS population included all enrolled participants who had taken at least 1 dose of drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BeneFactor IX (BeneFIX) | Percentage of Participants With Allergic-Type Allergic Reactions | 0 Percentage of Participants |
Percentage of Participants With Less Than Expected Therapeutic Effect (LETE)
The incidence of LETE for on-demand treatment was defined as no response after each of 2 successive infusions within 24 hours for the same bleeding event in the absence of confounding factors.
Time frame: Baseline up to 6 months
Population: FAS population included all participants who were treated and had at least 1 evaluable efficacy assessment after treatment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BeneFactor IX (BeneFIX) | Percentage of Participants With Less Than Expected Therapeutic Effect (LETE) | 0 Percentage of Participants |
Percentage of Participants With Red Blood Cell (RBC) Agglutination
RBC Agglutination is the clumping of red blood cells in the presence of an antibody. The antibody or other molecule bonded multiple particles and joined them, creating a large complex.
Time frame: Baseline up to 6 months
Population: SS population included all enrolled participants who had taken at least 1 dose of drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BeneFactor IX (BeneFIX) | Percentage of Participants With Red Blood Cell (RBC) Agglutination | 0 Percentage of Participants |
Percentage of Participants With Thrombosis
Thrombosis is the formation of a blood clot (thrombus) inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss.
Time frame: Baseline up to 6 months
Population: SS population included all enrolled participants who had taken at least 1 dose of drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BeneFactor IX (BeneFIX) | Percentage of Participants With Thrombosis | 0 Percentage of Participants |